1.
Sports Injury
Dr. Satyen Bhattacharyya
Associate Professor: BIMLS, Bardhaman
www.fitofine.in

2.
DEFINITION
• A sports injury is any bodily damage
sustained during participation in
competitive or noncompetitive athletic
activity. Sports injuries can affect bones or
soft tissue (i.e, muscles, ligaments,
tendons).

3.
DESCRIPTION
• Sports injuries are identified as either
acute or chronic. Acute sports injuries
are characterized by the sudden
appearance of symptoms, usually
associated with a single traumatic
accident. Signs and symptoms of acute
sports injuries include pain, swelling,
and deformity in the affected area, and
in the joint injuries, limited ability to
move the joint. Common acute sports
injuries include sprains and strains,
contusions (i.e, serious bruises), joint
dislocations, bone fractures, and
concussions.

4.
CLASSIFICATION
• Among the various classifications proposed for sports injuries the
one proposed by WILLIAMS (1971) is widely used and recommended.

5.
TYPES OF SPORTS INJURY
Acute :-
An injury that occurs suddenly such as a sprained ankle caused by
an awkward landing is known as an acute injury. E.g, Acute
tenosynovitis of wrist extensors in canoists.
Chronic :-
Chronic injuries are caused by repeated overuse of muscle
groups or joints. Poor technique and structural abnormalities can also
contribute to the development of chronic injuries.E.g, March fracture
in soldiers.

6.
Overuse injury :-
These are caused by excessive and repeated use of the same
muscle, joint or bone.

7.
Soft tissue injury
Muscle sprains, Strains and Bruises
Hard tissue
Joints and Bones
Dislocated joints
Fractured bones

8.
Most common sports injuries in upper limb.
Shoulder complex :
• Rotator cuff injury
• Shoulder dislocation
• Fracture clavicle
: Bicipital tendinitis or rupture
Elbow :
Tennis elbow
Golfer's elbow

9.
Wrist :
Wrist pain
Carpal tunnel syndrome
HAND:
• Mallet injury
• Baseball finger
• Jersey thumb

10.
Most common sports injuries in LOWER limb
• HIP
• Quadriceps strain
• Hip pain
• Groin pain due to adducter strain
• KNEE JOINT
• Jumpers knee
• Fracture patella
• Knee ligaments injuries
• Meniscal injuries.

11.
• LEGS
• Calf muscle strain
• Hamstrings sprain
• Ankle injuries
• Ankle sprain
• Injury to Achilles tendon

12.
• Foot
• March fracture
• Jones fracture

13.
• SHOULDER COMPLEX:

14.
Rotator cuff injury
The rotator cuff is made up of 4
group of muscles. The muscles
include the supraspinatus,
infraspinatus, teres minor
and subscapularis.
The scapula is responsible for
stabilizing the glenohumeral joint,
abducting, externally rotating and
internally rotating the humerus.

15.
Injury in sports
Rotator calf injury is common in athletes and sports persons.
Supraspinatus and Infraspinatus are the most commonly injured
rotator cuff muscles particularly in sports which involve a lot of
shoulder rotation for example bowling in cricket, pitching in baseball,
swimming and kayaking.
The injury is also more common in the older athlete, particularly
where long term overuse or degeneration is present.

16.
Supraspinatus tendon tear

17.
MECHANISMS

18.
CAUSES:
Repetitive stress: Repetitive overhead
movement of the arms can stress the rotator
cuff muscles and tendons causing
inflammation and eventually tearing.
Impingement : Falls or incorrect throwing
techniques or arm movements and weak
shoulder muscles may cause the humerus to
move up and trap the tendon.

19.
Calcium deposits : Calcium may deposits in the tendons due to
decrease oxygen and poor blood supply. This deposits may cause
irritation and inflammation.
Normal wear and tear : The rotator cuff tendons can degenerate due
to ages ( starting around 40). This can cause a breakdown of fibrous
protein ( collagen) in the cuff’s tendon and muscles.

20.
Symptoms
Pain in shoulder and radiate to arm.
Difficulty in movement especially to abduction.
Loss of range of motion.

21.
INVESTIGATION
Arthography
X RAY
MRI
Arthroscopy

22.
TREATMENT
Initial Care,Rest the shoulder,Ice pack
Immobilize the shoulder by sling
Medicine Anti inflammatory drug
Surgery
(If there is a large tear in rotator cuff, surgery may be needed to
repair the rotator cuff. This is two type open repair through 6 to 10
cm incision or as an arthroscopic incision).

23.
PHYSIOTHERAPY MANAGEMENT
During the initial acute stage rest in the sling.
Cryotherapy, UST, TENS, SWD
During the later stages Isometric exercises for shoulder joint
muscles, Mobilization of shoulder joint.
Exercise- Gravity eliminated abduction, Flexion extension
exercises, pendulum swing.
UST, TENS, SWD.

24.
TREATMENTS

25.
PREVENTION
Warm up stretching and strengthening of the shoulder muscles.
Avoiding certain sports which constantly cause friction to the
shoulder.
Avoiding sudden jerky movements and abrupt lifting of heavy
weights.

26.
shoulder
DISLOCATION
Shoulder dislocations occur when the head of the
humerus pops out of the shoulder joint.
It occurs more commonly in adults, and is rare in
children.

27.
TYPES OF DISLOCATION
Anterior Dislocation
In this injury, the head of the humerus comes out of the glenoid cavity
and lies anteriorly. This dislocation is more common the other
dislocations.
Subtypes depending on the position of the dislocated head,Preglenoid
Head lies in front of the glenoid.
Subcoracoid Head lies below the coracoid process.
Subclavicular Head lies below the clavicle.

28.
Posterior Dislocation
In this injury, the head of the humerus
comes to lie posteriorly behind the
glenoid.
Inferior dislocation (Luxatio erecta)
This is the rare type where the head
comes to lie in the subglenoid
position.

29.
Causes
Shoulder joint is the commonest
joint in the body to dislocate.
Shoulder joint is more mobile than
stable.
The glenoid cavity is small than the
head of the humerus.

30.
Injury in sports
• Shoulder dislocation common in
Football, Hockey, Gymnastic,
downhill skiing, Volleyball.

31.
SYMpTOMS
The patient enters the casualty
with his shoulder abducted and
the elbow is supported with
opposite hand.
Pain
Inability to move the shoulder.

32.
INVESTIGATION
X-ray
CT Scan

33.
TREATMENT
For acute dislocation reduction
under sedation or general
anaesthesia followed by
immobilisation of the shoulder
in a chest arm bandage for
three weeks.
Techniques of reduction
Kocher’s manoeuvre- Most
commonly used method. The
steps are as follows-
i)Traction
ii)External rotation
iii)Adduction
iv)Internal rotation

34.
PHYSIOTHERAPY
MANAGEMENT
Initial 3 weeks
Phase of immobilization and the affected
arm is fastened to the trunk in a position
of the adductuion and int. rotation.
Active exercises of wrist and finger.
Self isometric contraction of Biceps,
Triceps & Deltoid are begun.

35.
3 weeks later
• Strapping are removed and the limb is supported in a sling
• Shoulder Mobilization is done
• Flexion extension then abduction and ext. rotation
• Strengthening exercises

36.
FRACTURE
CLAVICLE
The clavicle is a S shaped
bone that act as a
structure between the
sternum and the
glenohumeral joint.
It gives power and
stability of the arm,
motion of the shoulder
gridle, protects neuro
vascular structures.

37.
MECHANISM OF
INJURY
Direct Due to fall on the
point of the shoulder.
This is the most common
mode of injury.
Direct trauma Over the
clavicle due to assault
RTA.
Indirect Fall on the
outstretched hands.

38.
INJURY IN SPORTS
• Fracture in clavicle common in
football, Biking, skating, ice hockey
etc.

39.
SYMPTOMS
Pain. Swelling.
Deformity.
Inability to
raise
shoulder.

40.
DIAGNOSIS
X-ray
CT scan

41.
TREATMENT
It may be conservative or surgical.
Conservative Treatment
Supports the arm in a sling Until the pain
subside, usually 1 to 3 weeks.
Figure of 8 bandage.
Clavicle ring, Analgesics.
Rehabilitation
The patient should be instructed regarding
hand, wrist and elbow exercises during
immobilization.
And regarding shoulder exercises once
fracture healed.

42.
Surgical Treatment
Closed reduction and percutaneous
fixation with K-wires
Open reduction and internal fixation
with plate screws.

43.
COMPLICATION
Neurovascular Injury- subclavian and brachial
plexus
Malunion- very common, cosmetic problem,
no treatment is required.
Nonunion- rare and requires open reduction,
rigid internal fixation and bone grafting.

44.
BICIPITAL TENDINITIS
• Bicep tendinitis is an
inflammation of the upper biceps
tendon. Also called the long head
of the biceps tendon, this strong,
cord like structure connects the
biceps muscle to the bones in the
shoulder.
• Pain in the front of the shoulder
and weekness are common
symptoms of biceps tendinitis.

45.
Causes
• Damage to the biceps tendon is due to a lifetime of normal
activities or overuse repeating the same shoulder motions
again and again.
• Overhead motion such as swimming,tennis & baseball.

46.
Symptoms
• Pain or tenderness in front of the
shoulder.
•
• Radiating pain towardas wrist.
• Pain in movement.
• Pain in overhead activity.

47.
INVESTIGATIONS
• X RAY
• MRI
• CT SCAN

48.
SPECIAL TESTS
• Speeds test
• Yergason test

49.
TREATMENT
Ice packs on shoulder for 20 to 30
minutes every 3 to 4 hours for 2 or 3
days.
Anti inflammatory oral steroid.
Corticosteroids.
Arthroscopic surgery
Open surgical repair.

50.
PHYSIOTHERAPHY MANAGEMENT
Transverse gliding
of the tendon &
cross friction
massage.
Electrical
stimulation and
UST.
Moist heat.
ROM EX. Of
shoulder with mild
stretching of the
biceps tendon.
Pendulam
exarcises.
Isometric execises
then eccentric
exercises.
Swiss ball exercises.
Rotator cuff
strengthening
exercises.

51.
EXERCISES

52.
PREVENTION
Avoid repetative
overhead activities
that cause
shoulder pain.
1
Maintain posture
2
Avoid lifting heavy
objects.
3
Perform rotator
cuff strengthening
ex. Regularly.
4

53.
ELBOW

54.
TENNIS ELBOW
This is a condition characterised
by pain and tenderness at the
later epicondyle of the humerus
due to non specific inflammation
at the origin of the extensor
muscles of the forearm.
It was first described from the
writer’s cramps by range in 1873.
it was Madris who called it as
“tennis elbow” shortly thereafter.

55.
CAUSES
Repeating the same motion over and over again like making roll for
chapatis.
Playing a racquet sports such as tennis or badminton
Carrying heavy loads
Constant more use computer keyboard and mouse.

56.
Famous sports man
who had Tennis Elbow

57.
SYMPTOMS
Pain may slowly increase around the
outside of the elbow.
Pain is worse when shaking hands or
squeezing objects.
Pain is made worse by stabilizing or
moving the wrist with force. Example
including lifting, opening jars, etc.

58.
INVESTIGATION
X-ray
MRI
Special Test
Cozen’s test

59.
TREATMENT
Conservative Treatment
Rest
Medicine
Anti inflammatory drugs for a weeks.
Hydrocortison injection
Elbow strap

60.
PHYSIOTHERAPY MANAGEMENT
Acute phase
Rest with POP splint
Ultrasound, SWD
Cryotherapy
Electrical Stimulation
Massaging
Active exercises ( Isometrics)
Progressive resisted exercises
Manipulation

61.
Post acute phase
Patient is instructed to avoid repeated wrist extension and supination
movement.
Exercises
passive exercises
resistive exercises
strengthening exercises
Surgical treatment also occur to relive severe pain for 6 weeks at least,
Failure to respond in any management.
After surgery physiotherapy is also done.

62.
EXERCISES

63.
GOLFER’S ELBOW
It is a tendinopathy of the insertion of
the epitrochlear muscles (Flexors of the
fingers of the hands and pronators).
The inflammation is at the origin of the
flexor tendons at the medial epicondyle
of the humerus.

64.
CAUSES
It affects men and
female equally.
Age mainly between
30 to 50 years.
Golfers elbow is
caused
predominately by
activities that require
repetitive or
excessive bending of
the wrist.
An incorrect golf
swing is a common
cause, but many
other sports or work
related activities can
caused the problem.

65.
• In sports mainly seen in
Golf,cricket,swimming, tennis players
are affected most.
• Due to repeted movements and
overload of flexor muscles
inflammation occurred at medial
epicondyle.

66.
SYMPTOMS
Pain and tenderness on the
inside of the elbow mainly at
the medial side of elbow.
Increase elbow pain when
bend or flex the wrist.
Gripping & squeezing down
tightly on an object increase
elbow pain.
Pain is worse when shaking
hand.

67.
INVESTIGATION
X-ray
MRI
Special Test - Medial epicondylitis test
Elbow flexed, forearm pronated-pain passivly flexed pt. wrist &
asked the pt. to extend the elbow, pt. forearm passivly supinated.
Pain in the medial side.

68.
Special test

69.
TREATMENT
Rest
Anti inflammatory medicine
Cortisone injection
ICE packs
Elbow strap

70.
PHYSIOTHERAPY
MANAGEMENT
Acute phase
• Rest with POP splint
• Ultrasound, SWD
• Cryotherapy
• Electrical Stimulation
• Massaging
• Active exercises ( Isometrics)
• Progressive resisted exercises
• Manipulation

71.
Post acute phase
Patient is instructed to avoid repeated wrist flexion
and pronation movement.
Exercises
passive exercises
resistive exercises
strengthening exercises
Surgical treatment also occur to relive severe pain
for 6 weeks at least, Failure to respond in any
management.
After surgery physiotherapy is also done

72.
CARPAL TUNNEL SYNDROME
The carpal tunnel is bounded by bones on
three sides and a ligament on one side. The
floor is an osseous arch formed by the carpal
bones and the roof is formed by the transverse
carpal ligament.
Carpal tunnl syndrome was first described by
Sir James Paget in 1854, but the term was
coined by Moerisch.

73.
It caused by compression of the median nerve in the carpal tunnel along
with the tendon of the flexor digitorum superficialis and flexor pollicis longus
muscles. The tunnel can narrow creating pressure on the nurve for a number
of reasons:
Traumatic wrist injury such as wrist sprain or broken wrist
Repetitive strain injury caused by the over used of the wrist.

74.
SYMPTOMS
Tingling
Numbness
Pain
Weakness
Clumsiness
Symptoms are more at night

75.
Some tests
Phalen’s test
The patient is asked to actively place the wrist in complete but
unforced flexion. If tingling and numbness are produced in the
median nerve distribution of the hand within 60 secs, the test is
positive.
Median nerve percussion test
The examiner gentaly taps the median nerve at the wrist. The test is
positive if there is tingling sensation present.

76.
PHALENS TEST

77.
TREATMENT
Non operative methods
Non steroidal anti inflammatory drugs
Steroids like prednisolone, tapering
Carpal tunnel splint
Physiotherapy Management
UST, SWD
Exercises Gentle relaxed passive movements, active assisted and active
movement of the wrist and fingers area.

78.
HAND

79.
MALLET INJURY
This is a flexion deformity of the DIP joint. It is an
injury of the extensor digitorum tendon of the
finger at the distal inter phalengeal joints.
It results from hyperflexion of the tendon
usually occur catching a cricket ball, basket ball
volley ball, in the bed tucking etc.

80.
SYMPTOMS
• Pain
• Swelling
• Deformity
• Tingling
• Unable to extend the finger

81.
INVESTIGATION
• Xray

82.
TREATMENT
• Closed splinting of the DIP joint in hyper
extension for 6- 8 weeks
• Night splinting for 4- 6 weeks.
• In avulsion fracture open reduction and internal
fixation.
• Ice packs.

83.
Rehabilitation
Exercises

84.
HIP
HIP:

85.
QUADRICEPS
STRAIN
A strain is a tear in a muscle or the tendon
that attaches the muscle to bone. A quadriceps
strain is a tear in the muscles on the front of the
thigh or their tendons. The quadriceps muscles
are important for straightening the knee and
bending the hip.

86.
STRAIN
• Classified into three categories-
• Grade -1 Cause pain but the tendon is not
lengthened.
• Grade-2 lengthened ligamint due to being
stretched,function is maintained.
• Grade-3 complete tear of tendon,function
impaired.

87.
Grades
of
STRAIN

88.
CAUSES
• Muscle tightness
• Muscle fatigue
• Muscle imbalances
• Incorrect exercise technique
• Inadequate warm up period
• Direct trauma

89.
INJURY IN
SPORTS
Mainly seen in
Football
Tennis
Cycling
Rugby
Running
Hockey

90.
SYMPTOMS
Pain, tenderness, inflammation.
Pain worsens witrh use of the quadriceps
muscles.
Muscle spasm
Difficulty in walking, running.
A crackling sound.
Loss of fullness.

91.
INVESTIGATIONS
• MRI
• USG

92.
TREATMENT
Anti inflammatory drugs- aspirin
Corticosteroid injection
Heat and cold theraphy
Surgery rarely needed, if the
strain is >3 then surgery needed.

93.
PHYSIOTHERAPHY
TREATMENT
• Reduce pain and inflammation.
• Protect the injury.
• Normalise the joint ROM
• Quadriceps and Hamstrings
strengthen.
• Knee cap
• Use of crutces
• Improve running, walking
techniques.
• Ice packs
• UST.

94.
PREVENTION
• Warm up and stetch properly
• Allow for adequate recovery
between workouts.
• Maintain physical fitness.
• Strength, flexibility, endurance
• Wear properly fitted and padded
protective equipment.

95.
HIP PAIN
• Defination
Hip pain is a common complaint
that can be caused by a wide
variety problems. Problems within
the hip joint tend to result in pain
on inside of hip or groin. Hip pain
on the outside hip, upper thigh, or
buttock caused by problems with
muscles, ligaments, tendons or
other soft tissues around hip.

96.
CAUSES
• ARTHRITIS
• Osteoarthritis
• Rheumatoid arthritis
• Septic arthritis
• INJURIES
• Bursitis
• Dislocation
• Hip fracture
• Sprains & strains
• Tendinitis

97.
SYMPTOMS
• Joint pain
• Groin pain
• Loss of motion of the hip
• Swelling over the hip
• Tenderness
• Difficulty sleeping on the hip
• Problems in movement
• Muscle weekness

98.
INVESTIGATIONS
• X-RAY
• MRI
• CT SCAN
• ULTASOUND

99.
TREATMENT
• Rest
• Ice packs
• Compression
• Elevation
• Anti inflammatory dugs
• Steroids
• Surgery rarely needed

100.
PHYSIOTHERAPHY TREATMENT
• Muscle stretching
• Core exercises
• Poor posture correction
• Gait analysis
• Dry needling
• Balance exercises
• Heat packs
• TENS
• Supportive taping and strapping
• Isometric exercises.

101.
Rehabe Exercises

102.
Knee

103.
Jumpers Knee
• Jumpers knee is also
known as patellar
tendinitis is a relatively
common cause of pain in
the inferior patellar
region in athletes. It is
common with frequent
jumping and studies
have shown it may be
associated with stiff
ankle movement and
ankle sprains.
•
• The term jumper’s knee
was first used in 1973 to
describe an insertional
tendinopathy.

104.
• Injury happened
particularly those
participating in jumping
sports such as basketball,
volleyball,football, high
or long jumping.
Tenderness is present over
the inferior pole.

105.
Signs and
Symptoms
• Anterior knee pain often with aching quality.Onset is
insidious.
Involvment of infrapatellar area may be surpapatellar.
Pain during athletic motion
Swelling
Bruising or redness
Discomfort during daily activites.

106.
Depending on the duration of
symptoms, jumpers knee can
be classified into 1 of 4 stages,
as follows~
Stage 1- Pain only after
activity, without functional
impairment.
Stage 2- Pain during and after
activity, although the patient
is still able to perform
satisfactorily in his or her
sport.

107.
Stage 3- Prolonged pain
during and after activity, with
increasing difficulty in
performing at a satisfactory
level.
Stage 4- Complete tendon
tear requiring surgical repair.
It begins as inflammation in
the patellar tendon where it
attaches to the patella & may
progress by tearing the
tendon.

108.
CAUSES
It is an overuse injury from
repetative overloading of the
extensor mechanism of the
knee. The microtears exceed
the body s healing mechanism
unless the activity is stopped.
Among the risk factors for
patellar tendonitis are low
ankle dorsiflexion, weak gluteal
muscles, and muscle tightness,
particularly in the calves,
quadriceps muscle, and
hamstrings.

109.
DIAGNOSIS
• X-RAY
• MRI
• Physical examination.
• Consideration of patient medical
history.

110.
TREATMENT
• NSAIDS include ibuprofen
• Rest, Ice, Compression and Elevation.
• Steroids injections
• Patellar tendon strap.
• Surgery (STAGE 4 INJURY )

111.
PHYSIOTHERAPHY
TREATMENT
• Decrease activities that increase patellofemoral
pressure
• (eg, jumping, squatting)
• Joint full ROM exercises
• Stretching- Hamstrings, rectus femoris, adductors,
quadriceps, gluteals, iliopsoas.
• Srengthening exercises.
• Cryotheraphy.
• Dry Needling.
• Sports specific proprioceptive training.
• UST.

112.
REHABE EXERCISES

113.
KNEE LIGAMENTS INJURY
The knee is the largest joint in our body and one of the most
complex.It is also vital yo movement.
Knee ligaments connect our thighbone to our lower leg
bones.Knee ligament sprains or tears are a common sports
injury.
In the past injuring more than one knee ligament would put an
end to future sports activities.Today many athletes are able to
return to high level sports following multiple ligament injuries.

114.
MAJOR
KNEE
LIGAMENTS
ACL- Anterior Cruciate Ligament.
PCL- Posterior Cruciate Ligament.
MCL- Medial Collateral Ligament.
LCL- Lateral Collateral Ligament.
Coronary Ligament.
Among them ACL & PCL are most
commonly injured in sports activities.

115.
ACL INJURY
• Anatomy:
•
• origin: Medial and anterior aspect of
the
tibial plateau.
• Insertion:Lateral femoral
condyle.
Function:
Prevents excessive tibial
medial & lateral rotation.
• Provides restraining force of
anterior translation.

116.
• One of the most common knee
injuries is an anterior cruciate
ligament sprain or tear.
• MECHANISM:
• Hyperextension force
• Twisting force on a semiflexed
knee.

117.
CLINICAL
FEATURES:
• Immediately collapse and is
painful.
• Popping sensation felt or heard.
• Swelling.
• Giving away.

118.
CLASSIFICATION:
• Ligaments sprain are classified in
three degrees:
• 1st Degree: Tear of only a few fibres of
the ligament.Minimal swelling,
localised tenderness but little
functional disability.
• 2nd Degree: Almost all the fibres of a
ligament are disrupted. Pain, swelling
and inability to use the limb.Normal
joint movements.
• 3rd Degree: Complete tear of the
ligament.

119.
DIAGNOSIS:
• Clinical Examinations.
• X-RAY
• MRI
• Arthroscopy (where doubt
persists).

120.
SPECIAL TESTS
• Lachmans test
• Anterior drawer test
• Pivot shift test.
• McMurrey test

121.
TREATMENT CONSERVATIVE:
Most cases of grades 1 and 2.
The hematoma is aspirated and the
knee is immobilized in a commercially
available knee immobilizer.
After a few weeks the adequate
strength can be regained by
physiotheraphy.

122.
OPERATIVE:
Indicated in multiple
ligaments injured knee,
especially in young athletes.
performed 2-3 weeks after
injury after acute phase
subside.

123.
• OTHERS METHOD:
• Rest, Ice, Compression and
Elevation.
• NSAIDS
• Corticosteroids.
• Knee Band.

124.
PHYSIOTHERAPHY
TREATMENT
• Mobility exercises:
• Static quads/SLR
• Ankle DF/PF/CIRCUMDUCTION
• Knee flexion/extension in sitting
• Patellar mobilisations
• Glute exercises in prone
• Knee flexion in prone.
• Strenghtening ex. Of knee

125.
• Neuromuscular electrical stimulatuin
• UST
• ICE packs
• Full ROM EX.
• VMO EX.

126.
PT
MANAGEMENT

127.
REHABE EXERCISES

128.
PCL INJURY
• ANATOMY:
ORIGIN:
The posterior intercondyler
area of the tibia.
INSERTION:
Medial condyle of the femur.
FUNCTION:
Keeps the tibia from moving
backwarda too far.

129.
• DEFINATION:
• It is less common
than ACL tears.
• MECHANISMS:
• Backward force on
tibia.

130.
CLINICAL
FEATURES:
• Pain and swelling that
occurs steadily and
quickly after the injury.
• Swelling that makes the
knee stiff.
• Difficulty in walking.
• The knee feels unstable
like it may give out.

131.
Sports are a common cause of
PCL injury.
• Football
• Soccer
• Baseball
• Skiing

132.
CLASSIFICATION
OF INJURY
• According to the severity:
• Grade 1- PCL has a partial tear .
• Grade 2- Ligament is partially torn and is
looser than grade 1.
• Grade 3- Ligament is completely torn and
the knee becomes unstable.
• Grade 4- PCL is damaged along with
another ligament of knee.

133.
DIAGNOSIS:
• X-RAY
• MRI
• BONE SCAN.
• ARTHROSCOPY

134.
SPECIAL TEST:
• Posterior Drawer test:

135.
TREATMENT:
• Protect, Rest, Icing, Compression, Elevation are performed.
• NSAIDS.
• Corticosteroids
• Surgery (grade 3 injury).

136.
PHYSIOTHERAPHY
TREATMENT:
• Using crutches at first, then gradually
walking with more weight on the knee.
• Full ROM exercises.
• Use a knee brace.
• Strengthening ex. of thigh muscles.
• Treadmill ex or walking or running in a
pool.
• Specific training needed for a sports.
• Neuromuscular electrical stimulation.
• UST.

137.
Rehabe exercises:

138.
Meniscal Injury
• The semilunar cartilages are two
crescent shaped plates of
fibrocartilage placed on condyler
surface of the tibia.
• FUNCTIONS-
• Increase the stability of knee.
• Controlling the complex rolling
and the gliding actions of the
joint.
• Distributing load during
movement.

139.
• Definition
Medial meniscus is more
commonly injured than the lateral
and is usually associated with other
ligament injuries of the knee.
Mainly seen in football, basketball,
cricket, rugby etc.

140.
CLASSIFICATION OF INJURY

141.
CAUSES
In young- twisting force
with the knee bent and
taking weight.
In Middile- fibrosis has
decreased the mobility
of meniscus and hence
tear occurs with less
force.
Over activity in sports.

142.
Clinical Features
• Usually a young person
• Pain usually on the middle side
• Knee is locked in partial flexion
• Swelling

143.
DIAGNOSIS
• McMurray s test
• Apley compression test

144.
• X-RAY
• MRI
• Artroscopy (where
doubt persits).

145.
Treatment
• Rest, ICE, compression, elevation.
• NSAIDS
• Corticosteroids
• Endurance and strength
• Surgery – arthroscopy technique

146.
Physiotheraphy treatment
• Muscle strengthening around knee mainly
quadriceps.
• Full active ROM exercises.
• Muscle stimulation.
• UST
• Weight bearing activities.

147.
Rehabe exercises

148.
Leg

149.
CALF MUSCLE
STRAIN:
• CALF MUSCLES :
• Gastrocnemius.
• Soleus.
• Plantaris.
• A calf strain occurs as a result of
these muscles being torn or
pulled. When a muscle is stretched
muscle fibers. The severity of
these tears depends on the depth
& suddenness of the stretch.

150.
CALF STRAIN :
GRADE 1: Mild strain.
GRADE 2: Moderate to severe pain.
GRADE3: A complete rupture.

151.
CAUSES:
• A calf strain occurs when the calf muscles
are over stretched.This can be caused by a
sudden abrupt movement or as a result of
over use.
• Insufficient warm up or cool down is a
common cause.
• Climbing or running up hills.
• Wearing inappropriate footwear.
• A sudden change of direction explosive
movement or increase in speed can result
in the calf muscles become torn or strained.

152.
SYMPTOMS:
• Sharp pain in the lower leg.
• Pain or resisted plantar flexion or
when standing on pointed toes.
• Swealing.
• Inflammation of the leg.
• Internal bleeding due to bruising
• Tightness
• Difficulty in weight bearing.
• A lump can be felt.

153.
DIAGNOSIS:
• Strength testing: pain will be
illiciated with resisted plantar
flexion against resistance.
• MRI
• X-RAY
• USG

154.
SPECIAL TEST:
• THOMPSON`s test

155.
TREATMENT:
• Rest-Ice-compression-elevation
• Strapping
• NSAIDS
• Orthotics-prevent overpronation.
• Kinesiology taping.

156.
PHYSIOTHERAPHY TREATMENT:
• Massage not in acute
condition
• Strengthening ex.
• Flexibility and
proprioceptive ex.
• Muscle of stretching.
• Weight calf ex.
• UST
• TENS
• MFR.

157.
REHABE EX:

158.
HAMSTRING STRAIN:
• A hamstring strain is a common leg injury
involving a tear in one or more of the
hamstring muscles. A hamstring strain can
range from mild to very severe involving a
complete tear of the hamstring muscle. Mainly
seen in soccer, basketball, tennis, football.

159.
HAMSTRING MUSCLES :
• SEMIMEMBRANOSUS.
• SEMITENDINOSUS.
• BICEPS FEMORIS – short & long head.

160.
CAUSES:
• Muscle stiffness
• Poor running mechanics
• Improper warm up.
• Inappropriate training loads.
• Fatigue
• Abnormalities of the lumber spine or poor
pelvic control.
• Playing surface: wet slippery surface.

161.
SYMPTOMS:
Tightness or low grade ache.
Sudden or severe pain during
exercises.
Pain in wailking, straightening the leg
or bending over.
Hamstring tenderness.
Bruising
Reffered hamstring pain due to sciatic
nerve compression.

162.
Diagnosis:
• Ultrasound scan.
• MRI.
• Grade 1: Tightness of the back of thigh but able to walk normnally.
Mild swealling and spasm may present.
• Grade 2: Walking pattern will be affected. pain, swelling, tenderness
present.
• Grade 3: A severe injury involving a tear to half or all the hamstring
muscle. Need crutches to walk. Pain & weakness in the muscle.

163.
Treatment:
• Rest, Ice, Elevation, Compretion.
• NSAIDS.
• Corcitosteroids.
• Avoid repeated injury.
• Hamstring caps

164.
Physiotheraphy Treatment:
Normalise ROM.
• Muscle strength.
• Muscle stretcing.
• Improve technique and function of running,
jumping, landing.
• Improve game speed, balance.
• Core ex, gait analysis, soft tissue massage.
• Tapping, support, HOT PACKS.
• Sports specific ex.
• TENS
• Dry needling.

165.
Exercises

166.
Ankle

167.
Ankle Sprain :
• Anatomy:
• Ligaments of the ankle:
• Anterior talofibular ligament
• Calcanofibular ligament
• Post talofibular ligament.

168.
• Ankle sprain is a common injury in
sports. If improperly treated it
may result in chronic laxity, pain or
delayed recovery.
• Mechanisms:
• Inversion of supinated planter
flexed foot.

169.
Clinical Features:
• Ant talofibular ligament
commonly injured followed by
calcaneofibular ligament.
• The post talofibular ligament is
rarely sprained.
• Pain, swelling and tenderness over
the affected ligament.

170.
Diagnosis:
• X-RAY.
• MRI.
• Ant Drawer Test: If the displacement of talus is more than 8 mm ant, it
suggests laxity of the ant talofibular ligament.
• Talar tilt test- If the tilt is more than 5 DEGREE it suggests laxity of ant
talofibular and calcaneofibular ligaments.

171.
A: Ant Drawer test.
B: Talar Tilt test.

172.
Management:
• Grade 1 :
• ICE, Compression bandage, foot
elevation, NSAIDS.
• Grade 2:
• Long leg cast, ROM EX,
strengthening ex.
• Grade 3:
• Same as grade 2 sometimes requir
surgical care.

173.
TREATMENT:

174.
Achilles Tendon
• The achilles tendon or heel cord also known as the calcaneal tendon is a
tendon of the back of the leg, and the thickest in human body. It serves to
attach the calf muscles to the calcaneus (heel) bone. These muscles acting
via the tendon, cause plantar flexion of the foot at the ankle and knee
flexion.

175.
Achilles Tendinities
• Achilles tendinitis is the tendinitis
of the achilles tendon caused by
overuse of the affected limb and is
more common among athletes
training under less than ideal
conditions.

176.
Signs & Symptoms
• Symptoms can vary from an ache
or pain and swelling to the local
area of the ankles or a burning
that surrounds the whole joint.
With this condition the pain is
usually worse during and after
activity and the tendon and joint
area can become stiffer the
following day as swelling impings
on the movement of the tendon.

177.
CAUSES
• Achilles tendon injuries are common in people who
do things where they quickly speed up, slow down,
or pivot such as;
• Running
• Gymnastics
• Football
• Baseball
• Tennis
• Basketball
• Tight leg muscle.

178.
Diagnosis:
• X-RAY
• MRI
• USG
• Physical Examination.

179.
Treatment:
• Rest: avoid putting weight on legs. Need
crutches
• Ice: icing for 20 minutes
• Compress leg: use an elastic bandage around
ankle to keep down swelling.
• Raise leg
• NSAIDS: Ibuprofen, Naproxen.
• Use a heel lift.
• Surgery

180.
PT Management:
• Calf muscle stretching
• Strenghtening ex.
• ROM ex.
• Active daily ex.
• Extracorporeal shock wave theraphy
• UST
• Tapping
• Night splints.
• Laser

181.
Rehabe exercises:

182.
Foot

183.
March Fracture:
• Also known as fatigue fracture
or stress fracture of metatarsal
bone, is the fracture of the
distal third of one of the
metatarsals occuring because
of recurrent stress.
• Its one of the most
common sports injuries. Mainly
seen in running, football,
basketball due to heavy stress
in lower bones.

184.
Stages in
development:
1. Crack initiation.
2. Crack propagation.
3. Rapid failure of bone.
Bone can repair itself quickly
pathological strain is removed
before the third stage.

185.
Clinical features:
• History of unaccustomed &
repeated activity.
• Pain after ex. Pain during ex.
Pain without ex.
• Load related pain.
• Swealling.
• Tenderness.
• Leg lenth discrepancy, muscle
imbalance excessive subtalar
pronation.

186.
Diagnosis:
• X-RAY
• CT SCAN
• MRI - for more specific.

187.
Treatment:
• Rest to allow the bone remodeling
process.
• Identify and correct any predisposing
factor.
• Training errors- identified and
corrected.
• Non wt bearing cast immobilisation.
• ice., compression .
• NSAIDS
• CORTICOSTEROIDS.

188.
PT
Management.
• Mobilisation
• Active rom ex.
• Strengtening ex
• UST
• LASER.

189.
THANK YOU.